Abstract：
:As scientists and physicians have gained sophistication in understanding and treating illness, our view of disease has changed in scope. We appreciate more fully the diverse and wide-ranging effects of stress on the ability of the organism to maintain homeostasis. As our study of the failure of homeostasis has advanced from the organ to the intracellular level, we have gained insight into processes that, through conveyance of chemical messages, cross organ boundaries to tie together multiple systems involved in preserving metabolic balance. We have come to recognize that our pharmacologic interventions are seldom unique in the sense of providing the patient with an entirely new means of fighting an illness; we more often support a system that has been deranged by disease or injury, using agonists, inhibitors, buffers, substitutes, supplements, and mechanical devices in hopes that the body will adjust to its stresses over time. Multiple receptor systems have been studied in regard to their function in normal and abnormal states. Of primary impact on the critically ill patient are adrenergic, thyroid, and insulin receptors, which are of major importance in maintaining metabolic stability and are either the targets of many of our therapies or are inadvertently affected by them in adverse ways. Of doubtless importance, but currently with less clinical application in this setting, are steroid, cholinergic, and histamine receptors. The recent growth of data concerning the role of endogenous opioids in the response to stress will, it is hoped, add to our armamentarium in the future. Future research in signal transduction will continue to increase our understanding of the mechanisms through which our patients maintain homeostasis in the face of disease, as well as our role in helping to regain a balance that has been lost. With further study, we may develop pharmacologic agents that allow us to effect changes with greater tissue or subcellular specificity and hence more specific physiologic consequences. As in many other fields of medicine, continued description of normal states will aid in recognition of defects in the abnormal, or unregulated, state, by understanding derangements in control that can result in primary disease.
journal_name
Crit Care Clinjournal_title
Critical care clinicsauthors
Weise KLsubject
Has Abstractpub_date
1988-10-01 00:00:00pages
695-709issue
4eissn
0749-0704issn
1557-8232journal_volume
4pub_type
杂志文章,评审abstract：:Intoxications frequently perturb acid-base and electrolyte status, intravascular volume, and renal function. In selected cases, extracorporeal techniques effectively restore homeostasis and augment intoxicant removal. The use of 4-methylpyrazole, an inhibitor of alcohol dehydrogenase, is a new and effective treatment ...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/s0749-0704(01)00011-2
更新日期：2002-04-01 00:00:00
abstract：:Recent increase in both the elderly population and associated incidence of dementia are of critical importance to patient care in ICUs in the United States. Identification of pre-existing cognitive impairment, such as mild cognitive impairment and dementia, could prevent delirium and associated morbidity and mortality...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2008.05.006
更新日期：2008-10-01 00:00:00
abstract：:The use of ultrasonography in medical practice has evolved dramatically over the last few decades and will continue to improve as technological advances are incorporated into daily medical practice. Although ultrasound machine size and equipment have evolved, the basic principles and fundamental functions have remaine...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2013.08.006
更新日期：2014-01-01 00:00:00
abstract：:Both limb muscle weakness and respiratory muscle weakness are exceedingly common in critically ill patients. Respiratory muscle weakness prolongs ventilator dependence, predisposing to nosocomial complications and death. Limb muscle weakness persists for months after discharge from intensive care and results in poor l...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2018.03.005
更新日期：2018-07-01 00:00:00
abstract：:The metabolic response to injury can induce a state of hypermetabolism that results in the rapid loss of the body nitrogen, so that a critical reduction in lean body mass that affects morbidity and mortality can occur in a short period of time. The process also induces a redistribution of the body nitrogen away from t...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1988-07-01 00:00:00
abstract：:Although our understanding of molecular events in septic shock is growing exponentially, bedside management has changed only incrementally over the last 20 years. In pediatric and adult patients alike, treatment continues to be largely supportive. Morbidity and mortality, though gradually improving, continue to be hig...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/s0749-0704(05)70328-6
更新日期：1997-07-01 00:00:00
abstract：:The energy expenditure of the critically ill patient is influenced by many factors, thus making it difficult to predict. Measurement of energy expenditure in mechanically ventilated patients receiving elevated oxygen concentrations requires a good understanding of the measurement technique and its limitations, whether...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1987-01-01 00:00:00
abstract：:Infection and/or sepsis biomarkers should help to make the diagnosis and thus initiate therapy earlier, help to differentiate between infectious and sterile inflammation, allow the use of more-specific antimicrobials, shorten the time of antimicrobial use, and ideally identify distinct phenotypes that may benefit from...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2011.01.002
更新日期：2011-04-01 00:00:00
abstract：:Alterations in hemostasis are common in patients with cancer admitted to the ICU. Depending on the underlying disease and specific hemostatic abnormality, the patient with cancer may develop bleeding, thrombosis, or both, such as DIC. Bleeding complications usually result from abnormalities in platelets or deficiency ...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/s0749-0704(05)70200-1
更新日期：2001-07-01 00:00:00
abstract：:It is as important to monitor the passage of time in the resuscitation effort as it is to follow the physiologic parameters. The goals in resuscitation are based on restoring cellular metabolism to a level consistent with optimum survival. The level of invasiveness of monitoring is dictated by the extent to which the ...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1992-04-01 00:00:00
abstract：:Sedative drugs commonly are titrated to effect in critically ill patients. Subjective clinical assessment tools are used to determine the patient's level of sedation, and there clearly is a need for improved quantitative methods of monitoring sedation. This article describes the current methods for assessing the level...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1995-10-01 00:00:00
abstract：:Vancomycin-resistant enterococci (VRE) consist mainly of Enterococcus faecalis and E faecium, the latter mostly hospital-acquired. In addition, E gallinarum and E casseliflavus are intrinsically vancomycin-resistant and are community-acquired. VRE have become common in many hospitals throughout the world and, once est...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2013.06.006
更新日期：2013-10-01 00:00:00
abstract：:The known metabolic abnormalities and nutritional requirements of the brain injury, spinal cord injury, and acute stroke patient have been presented. Further investigations are required in all these conditions to identify specific nutritional requirements and metabolic abnormalities. The specific role of nutritional s...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1987-01-01 00:00:00
abstract：:Carbon monoxide (CO) poisoning is common and frequently unrecognized since the signs and symptoms are relatively nonspecific. CO poisoning causes tissue hypoxia. Additionally, various animal studies have demonstrated that CO interferes with myoglobin, P450, and other enzyme function; causes lipid peroxidation through ...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/s0749-0704(05)70056-7
更新日期：1999-04-01 00:00:00
abstract：:Clinicians are confronted with a complex challenge when a patient is admitted to a critical care unit (CCU) with a significant chest roentgenography (CXR) abnormality. The etiology of a new infiltrate seen on CXR in a patient already in the CCU is more difficult to establish, but is of equal concern. ...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/s0749-0704(05)70383-3
更新日期：1998-01-01 00:00:00
abstract：:The management of critically ill patients necessitates the use of sedatives and analgesics to provide patient comfort and cooperation. These drugs exert profound effects on all organ systems, not only the central nervous system, and this article describes the immunologic effects of the commonly used critical care seda...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2009.05.001
更新日期：2009-07-01 00:00:00
abstract：:Management of the cardiac transplant recipient includes careful titration of inotropes and vasopressors. Recipient pulmonary hypertension and ventilatory status must be optimized to prevent allograft right ventricular failure. Vasoplegia, coagulopathy, arrhythmias, and renal dysfunction also require careful management...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2018.08.008
更新日期：2019-01-01 00:00:00
abstract：:Decisions to admit and discharge patients to and from the intensive care unit (ICU) when resources are scarce should be made according to the triage principle--that is, resources should be allocated based on the patient's ability to benefit from critical care. The ICU organizational structure and the constraints on de...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1993-07-01 00:00:00
abstract：:The availability, portability, safety, and other features of ultrasound have ushered this relatively new imaging modality into the everyday clinical practice of multiple disciplines. Features unique to ultrasound lend this imaging modality the opportunity for extensive use in the ICU. A review of its uses in this capa...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/s0749-0704(05)70097-x
更新日期：2000-01-01 00:00:00
abstract：:Patients with CCI have continuing profound medical needs, poor prognosis for significant functional recovery, and a high mortality rate. Nonetheless, some survive for months or years, but unfortunately, often with functional skills and quality of life lower than need be. Careful evaluation of each patient's medical co...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/s0749-0704(02)00011-8
更新日期：2002-07-01 00:00:00
abstract：:The five components integral to modern, sophisticated airway management in trauma patients include equipment, pharmacologic adjuncts, manual techniques, physical circumstances, and patient profile. Although there is a finite number of pieces and types of equipment, pharmacologic adjuncts, and manual techniques, the la...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1990-01-01 00:00:00
abstract：:The consequences of acute and chronic drug abuse pose significant problems for physicians managing the trauma victim in the resuscitative, perioperative, intensive care, and hospitalization periods. Substance abuse, whether acute or chronic, modifies the physiologic response to injury and to resuscitative and operativ...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1994-07-01 00:00:00
abstract：:Summarizing the mission of the ICU, the institution directive board and the unit director must generate a structure, proceedings criteria, management, and analysis of results capable of providing satisfactory care. Furthermore, they must take into account each organizational aspect that is necessary to offer an approp...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2006.04.002
更新日期：2006-07-01 00:00:00
abstract：:Vasodilators that affect the pulmonary vasculature are appealing adjuncts in many cardiopulmonary conditions that require mechanical ventilation such as ARDS, COPD, PPHN, and cardiothoracic surgery. The adverse systemic effects of parenteral PGE1 and parenteral prostacyclin limit their usefulness in critically ill pat...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/s0749-0704(05)70023-3
更新日期：1998-10-01 00:00:00
abstract：:Good airway management depends on a system that emphasizes teamwork to expedite care and minimize errors. By understanding the accreditation and licensing requirements, appropriate personnel and equipment can be allocated along cost effective guidelines. Newer techniques for management of the difficult airway, such as...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/s0749-0704(05)70129-9
更新日期：2000-07-01 00:00:00
abstract：:In July 2001, the United States Joint Commission on Accreditation of Health care Organizations adopted a new leadership standard that requires department heads in health care organizations to perform at least one Failure Mode and Effects Analysis (FMEA) every year. This proactive approach to error prevention has prove...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2004.07.005
更新日期：2005-01-01 00:00:00
abstract：:There are numerous mechanisms of hypoxemia and hypercapnia during the perioperative period. Mechanisms of hypoxemia include oxygen delivery problems, decreased FAC-CC relationship, hypoventilation, decreased cardiac output, increased oxygen consumption, decreased hypoxic pulmonary vasoconstriction, and increased nonal...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1987-04-01 00:00:00
abstract：:Positive-pressure ventilation may improve gas exchange, decrease the work-cost of breathing, and rest respiratory muscles, but it also will alter cardiac output and may modify blood flow distribution. Ventilation may induce these hemodynamic changes by altering systemic venous return to the RV (RV preload), pulmonary ...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1990-07-01 00:00:00
abstract：:The thermal-dye technique for the measurement of ELW is available for clinical and experimental use. This method is safe and can be performed serially in an individual patient. Although it is invasive, it requires only a central venous catheter and an arterial catheter, which are often already in place for routine hem...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1986-07-01 00:00:00
abstract：:Providing nutritional support has become a standard component of managing critically ill patients. While many studies have documented that providing nutritional support can change nutritional outcomes (e.g., amino acid profile, weight gain, nitrogen balance), data are lacking that demonstrate that nutrition actually i...
journal_title：Critical care clinics
pub_type： 杂志文章,meta分析
doi：10.1016/s0749-0704(05)70009-9
更新日期：1998-07-01 00:00:00
